Theresa A Bistline, PTA
Individual provider Active NPI Physical Therapy Assistant · Glenolden, PA
NPI 1386476232 · NPPES record last updated Aug 19, 2024
Key facts
- NPI
- 1386476232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- TE012170 (PA)
- Practice address
- 901 W Ashland Ave
Glenolden, PA 19036-1101 - Phone
- (610) 461-6522
- NPI assigned
- Aug 19, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TE012170 | PA | MD | Physical Therapy Assistant |
| MSG015380 | PA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Excelsia Physicians Group LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MSG015380 | PA | |
| Physical Therapy Assistant | 225200000X | TE012170 | PA | Yes |
Addresses
Primary practice location
901 W Ashland Ave
Glenolden, PA 19036-1101
Mailing address
901 W Ashland Ave
Glenolden, PA 19036-1101
Phone (610) 461-6522
Other practice location 1
110B W Germantown Pike
East Norriton, PA 19401-1348
Phone (610) 801-1872
Other providers in Glenolden, PA
- Season Apple
- Elizabeth Ourai Bangura
- Patricia Bell
- Eileen M Bellew
- Brian Bird
- Amanda Michelle Bonus
- Manmohan Singh Boparai
- Briarcliffe Fire Company
- Melanie Brockenbrough
- Careline Home Care Agency LLC
All providers in Glenolden, PA · Physical Therapy Assistant in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.